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van Os S, Ryder N, Hart DP, Troop N. Adherence to prophylaxis in adolescents and young adults with severe haemophilia: a qualitative study with healthcare professionals. Health Psychol Behav Med 2020; 8:55-72. [PMID: 34040862 PMCID: PMC8114349 DOI: 10.1080/21642850.2020.1718501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/11/2020] [Indexed: 11/02/2022] Open
Abstract
Aim: to examine healthcare professionals' (HP) perceptions and experiences in relation to adherence to prophylactic treatment among young people living with haemophilia (YPH). Methods: All HPs in four haemophilia centres across England and Wales were invited to participate, and all HPs who agreed to take part (n = 6) were interviewed. Interviews were audio-recorded, transcribed and then analysed using Interpretative Phenomenological Analysis (IPA). Results: HPs estimate that generally young people with haemophilia keep to their treatment regimen well, although they also recognise that adherence may fluctuate with many patients going through shorter periods of non-adherence. The increasingly personalised or flexible approach to prophylaxis makes it harder to assess adherence. The main themes identified through IPA included (1) HPs' suggest that adherence fluctuates (2) Non-adherence is mainly driven by lifestyle and developmental, social and family factors, and (3) Education, HPs' sensitivity to individual needs, and psychological and peer support are key facilitators of good adherence. Conclusion: The increasingly flexible approach to prophylaxis requires a new way of thinking about, and assessment of, adherence. More personalised treatment regimen can be more complicated and may, therefore, lead to accidental non-adherence. The results of this study with HPs complement those of a previous qualitative study with patients but place greater emphasis on a broader perspective on understanding drivers of non-adherence as well as understanding strategies to improve adherence in the minority of patients who appear to struggle.
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Affiliation(s)
- S. van Os
- Psychology and Sport Sciences Department, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - N. Ryder
- Psychology and Sport Sciences Department, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - D. P. Hart
- The Royal London Hospital Haemophilia Centre, Barts Health NHS Trust, London, UK
- Barts and The London School of Medicine and Dentistry, QMUL, London, UK
| | - N. Troop
- Psychology and Sport Sciences Department, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
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2
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Collins PW, Liesner R, Makris M, Talks K, Chowdary P, Chalmers E, Hall G, Riddell A, Percy CL, Hay CR, Hart DP. Treatment of bleeding episodes in haemophilia A complicated by a factor VIII inhibitor in patients receiving Emicizumab. Interim guidance from UKHCDO Inhibitor Working Party and Executive Committee. Haemophilia 2018; 24:344-347. [PMID: 30070072 DOI: 10.1111/hae.13495] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 02/03/2023]
Abstract
Emicizumab is a bispecific antibody that activates FX to FXa in the absence of FVIII. It has been shown to reduce bleeding episodes in people with haemophilia A complicated by a FVIII inhibitor. Despite the protection against bleeds, some breakthrough bleeds are inevitable and these may require additional haemostatic treatment. Emicizumab has been associated with severe adverse events when co-administered with activated prothrombin complex concentrate. To minimize the risk of adverse events, the UK Haemophilia Centre Doctors' Organisation issues the following updated interim guidance to its Inhibitor Guidelines for managing patients receiving Emicizumab based on the limit published information available in February 2018.
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Affiliation(s)
| | - R Liesner
- Great Ormond Street Hospital, London, UK
| | - M Makris
- University of Sheffield, Sheffield, UK
| | - K Talks
- Royal Victoria Infirmary, Newcastle, UK
| | | | - E Chalmers
- Royal Hospital for Children, Glasgow, UK
| | - G Hall
- John Radcliffe Hospital, Oxford, UK
| | | | - C L Percy
- Queen Elizabeth Hospital, Birmingham, UK
| | - C R Hay
- Central Manchester University Hospitals, Manchester, UK
| | - D P Hart
- Barts and The London School of Medicine and Dentistry, Queen Mary University London, Royal London Hospital, London, UK
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3
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van Os S, Troop N, Ryder N, Hart DP. Adherence to prophylaxis in adolescents and young adults with severe haemophilia A, a qualitative study with patients. Health Psychol Behav Med 2018; 6:277-300. [PMID: 34040833 PMCID: PMC8114393 DOI: 10.1080/21642850.2018.1493384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Reported levels of adherence to prophylaxis among young people with haemophilia (YPH) vary widely and are predominately based on estimations made by healthcare professionals and parents. Reasons for (non)adherence among YPH in particular have not been evidenced. Aim: to examine experiences in relation to prophylaxis with YPH themselves, and barriers and facilitators to their adherence. Methods: 11 Participants were recruited in five haemophilia centres across England and Wales. All patients who met the inclusion criteria (aged 12-25, diagnosed with haemophilia, on prophylaxis) were approached during a routine check-up appointment, and all participants who agreed to take part were interviewed. Interviews were audio recorded, transcribed and analysed using Interpretative Phenomenological Analysis. Results: Self-reported adherence to prophylaxis was good. Few participants admitted to intentionally skipping injections although they reported sometimes forgetting. However, due to the increasingly personalised and flexible approach to prophylaxis, adherence is not straightforward to define. Barriers to adherence included a busy lifestyle, dislike of the intravenous injection, venous access issues, anxiety or stress and being out of one’s normal routine. Support was an important facilitator to adherence, including support from health professionals at the haemophilia centre as well as friends. Parents appear to be very involved with their child’s haemophilia management, even after they leave home. Conclusion: What this study adds is that the increasingly flexible and personalised approach to managing prophylaxis in haemophilia may sometimes lead to confusion around treatment frequency and dosing. This may lead to accidental non-adherence, which is distinct from both skipping and forgetting. Advice from haemophilia teams may not always be consistent and is likely to be interpreted differently by different individuals. Some additional training and education of patients and their families to increase their knowledge and skills around prophylaxis may reduce this confusion and therefore is likely to improve adherence further.
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Affiliation(s)
- S van Os
- Department of Applied Health Research, University College London, London, UK
| | - N Troop
- Psychology and Sport Sciences Department, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - N Ryder
- Psychology and Sport Sciences Department, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - D P Hart
- The Royal London Hospital Haemophilia Centre, Barts Health NHS Trust, London, UK.,Barts and The London School of Medicine and Dentistry, QMUL, London, UK
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Stoffman J, Andersson NG, Branchford B, Batt K, D'Oiron R, Escuriola Ettingshausen C, Hart DP, Jiménez Yuste V, Kavakli K, Mancuso ME, Nogami K, Ramírez C, Wu R. Common themes and challenges in hemophilia care: a multinational perspective. ACTA ACUST UNITED AC 2018; 24:39-48. [PMID: 30073913 DOI: 10.1080/10245332.2018.1505225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To identify ways that provision of hemophilia care can be maximized at the local level, irrespective of available resources or cultural or geographic challenges. METHODS The SHIELD group used its multinational experience to share examples of local initiatives that have been employed to deliver optimal hemophilia care. RESULTS The examples were reviewed and categorized into four key themes: guidelines and algorithms for delivery of care; collaboration with patients and allied groups for care and education; registries for the monitoring of treatment and outcomes and health care planning and delivery; and opportunities for personalization of care. These themes were then incorporated into a road map for collaborative care in hemophilia that reflected the contribution of best practice. DISCUSSION Differing healthcare reimbursement systems, budgetary constraints, and geographical and cultural factors make it difficult for any country to fully deliver ideal care for people with hemophilia. The SHIELD approach for collaborative care provides illustrative examples of how four key themes can be used to optimize hemophilia care in any setting. ABBREVIATIONS AHCDC: Association of Hemophilia Clinic Directors of Canada; AICE: Italian Association of Hemophilia Centres; ATHN: American Thrombosis and Hemostasis Network; EAHAD: European Association for Haemophilia and Allied Disorders; EHC: European Hemophilia Consortium; FIX: Coagulation Factor IX; FVIII: Coagulation Factor VIII; HAL: Haemophilia Activity List; HJHS: Haemophilia Joint Health Score; HTC: Hemophilia Treatment Centre; HTCCNC: Hemophilia Treatment Centre Collaborative Network of China; MASAC: Medical and Scientific Advisory Council; MDT: Multidisciplinary team; NHD: National Haemophilia Database; NHF: National Hemophilia Foundation; PK: Pharmacokinetics; POCUS: Point of care ultrasound; PWH: People with haemophilia; SHIELD: Supporting Hemophilia through International Education, Learning and Development; WFH: World Federation of Hemophilia.
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Affiliation(s)
- J Stoffman
- a Department of Pediatrics and Child Health , University of Manitoba , Winnipeg , Canada
| | - N G Andersson
- b Department for Thrombosis and Haemostasis Hematology , Skåne University Hospital , Scania , Sweden
| | - B Branchford
- c School of Medicine Research Complex 1 , University of Colorado , Aurora , CO , USA
| | - K Batt
- d Wake Forest Baptist University Medical Center, 1 Medical Center Blvd , Winston-Salem , NC , USA
| | - R D'Oiron
- e Centre de Traitement de l'Hémophilie et Maladies Hémorragiques Constitutionnelles Rares , Hôpitaux Universitaires Paris Sud - Hôpital Bicêtre , Le Kremlin-Bicêtre Cedex , France
| | | | - D P Hart
- g The Royal London Hospital Haemophilia Centre , Barts and The London School of Medicine & Dentistry , London , UK
| | - V Jiménez Yuste
- h Hospital Universitario La Paz - Hematology , Madrid , Spain
| | - K Kavakli
- i Department of Hematology , Ege University Children's Hospital , Izmir , Turkey
| | - M E Mancuso
- j Angelo Bianchi Bonomi Haemophilia and Thrombosis Centre , University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan , Milan , Italy
| | - K Nogami
- k Department Pediatrics , Nara Medical University , Kashihara, Nara , Japan
| | - C Ramírez
- l Clinica Colsanitas , Fundación Universitaria Sanitas , Bogota , Colombia
| | - R Wu
- m Hemophilia Work Group, Hematology-Oncology Center , Beijing Children's Hospital affiliated to Capital Medical University , Beijing , People's Republic of China
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Batty P, Hart DP, Platton S. Optimization of pre-analytical heat treatment for inhibitor detection in haemophilia A. Int J Lab Hematol 2018; 40:561-568. [PMID: 29777571 DOI: 10.1111/ijlh.12862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Factor VIII (FVIII) antibody formation is the greatest clinical and laboratory challenge within the haemophilia centre. The Nijmegen-Bethesda assay (NBA) is the gold standard for inhibitor quantification, but affected by pre-analytical variables including a patient's FVIII activity (FVIII:C). Pre-analytical heat treatment (PHT) provides a methodology for inhibitor testing when measurable FVIII:C is present. METHODS We evaluated the effect of different PHT conditions (time/temperature) on FVIII:C as well as on potency of inhibitory activity in samples containing FVIII:C (endogenous pooled plasma and exogenous recombinant FVIII (rFL-FVIII) concentrate) or FVIII inhibitor. RESULTS PHT of endogenous FVIII at 37°C, 47°C and 52°C resulted in declining measurable FVIII:C at 120 minutes (69%, 57% and 13% of the original FVIII:C, respectively). Incubation at 56°C resulted in FVIII:C ≤ 1IU/dL after 60 minutes for endogenous FVIII and 120 minutes for rFL-FVIII. Incubation at 58°C resulted in FVIII:C < 1IU/dL at 15-30 minutes for endogenous FVIII and at 30-60 minutes for rFL-FVIII. No difference was seen for inhibitor detection following PHT (56°C or 58°C) by NBA or anti-FVIII IgG ELISA. CONCLUSION PHT at 58°C for 30 minutes demonstrated consistent reduction in FVIII:C < 1IU/dL without appearing to affect inhibitor detection. Laboratory awareness of differences in thermostability of different sources of FVIII is important when choosing PHT conditions.
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Affiliation(s)
- P Batty
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, QMUL, London, UK.,The Royal London Hospital Haemophilia Centre, Barts Health, The Royal London Hospital, London, UK
| | - D P Hart
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, QMUL, London, UK.,The Royal London Hospital Haemophilia Centre, Barts Health, The Royal London Hospital, London, UK
| | - S Platton
- The Royal London Hospital Haemophilia Centre, Barts Health, The Royal London Hospital, London, UK
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6
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Collins P, Chalmers E, Alamelu J, Hay C, Liesner R, Makris M, Mathias M, Payne J, Rangarajan S, Richards M, Talks K, Tunstall O, Williams M, Hart DP. First-line immune tolerance induction for children with severe haemophilia A: A protocol from the UK Haemophilia Centre Doctors' Organisation Inhibitor and Paediatric Working Parties. Haemophilia 2017; 23:654-659. [DOI: 10.1111/hae.13264] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 12/29/2022]
Affiliation(s)
- P. Collins
- Arthur Bloom Haemophilia Centre; University Hospital of Wales; Cardiff UK
| | - E. Chalmers
- Haemophilia Centre; Royal Hospital for Children; Glasgow UK
| | - J. Alamelu
- Haemophilia Centre; Evelina London Children's Hospital; London UK
| | - C. Hay
- Haemophilia Centre; University Departmentt of Haematology; Manchester UK
| | - R. Liesner
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - M. Makris
- Sheffield Haemophilia and Thrombosis Centre; Royal Hallamshire Hospital; Sheffield UK
| | - M. Mathias
- Haemophilia Centre; Great Ormond Street Hospital for Children NHS Foundation Trust; London UK
| | - J. Payne
- Departement of Haematology; Sheffield Children's Hospital; Sheffield UK
| | - S. Rangarajan
- Haemophilia Centre; Hampshire Hospitals NHS Foundation Trust; Basingstoke UK
| | - M. Richards
- Haemophilia Centre; Department of Paediatric Haematology; Leeds Children's Hospital; Leeds UK
| | - K. Talks
- Haemophilia Centre; Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTH); Newcastle UK
| | - O. Tunstall
- Department of Paediatric Haematology; Bristol Royal Hospital for Children; Bristol UK
| | - M. Williams
- Department of Haematology; Birmingham Children's Hospital; Birmingham UK
| | - D. P. Hart
- Barts and The London School of Medicine & Dentistry, QMUL; London UK
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7
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Kitchen S, Blakemore J, Friedman KD, Hart DP, Ko RH, Perry D, Platton S, Tan-Castillo D, Young G, Luddington RJ. A computer-based model to assess costs associated with the use of factor VIII and factor IX one-stage and chromogenic activity assays. J Thromb Haemost 2016; 14:757-64. [PMID: 26748742 DOI: 10.1111/jth.13253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/24/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Measurement of coagulation factor factor VIII (FVIII) and factor IX (FIX) activity can be associated with a high level of variability using one-stage assays based on activated partial thromboplastin time (APTT). Chromogenic assays show less variability, but are less commonly used in clinical laboratories. In addition, one-stage assay accuracy using certain reagent and instrument combinations is compromised by some modified recombinant factor concentrates. Reluctance among some in the hematology laboratory community to adopt the use of chromogenic assays may be partly attributable to lack of familiarity and perceived higher associated costs. OBJECTIVES To identify and characterize key cost parameters associated with one-stage APTT and chromogenic assays for FVIII and FIX activity using a computer-based cost analysis model. METHODS A cost model for FVIII and FIX chromogenic assays relative to APTT assays was generated using assumptions derived from interviews with hematologists and laboratory scientists, common clinical laboratory practise, manufacturer list prices and assay kit configurations. RESULTS Key factors that contribute to costs are factor-deficient plasma and kit reagents for one-stage and chromogenic assays, respectively. The stability of chromogenic assay kit reagents also limits the cost efficiency compared with APTT testing. Costs for chromogenic assays might be reduced by 50-75% using batch testing, aliquoting and freezing of kit reagents. CONCLUSIONS Both batch testing and aliquoting of chromogenic kit reagents might improve cost efficiency for FVIII and FIX chromogenic assays, but would require validation. Laboratory validation and regulatory approval as well as education and training in the use of chromogenic assays might facilitate wider adoption by clinical laboratories.
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Affiliation(s)
- S Kitchen
- Royal Hallamshire Hospital, Sheffield, UK
| | - J Blakemore
- Cambridge Consultants Limited, Cambridge, UK
| | | | - D P Hart
- Barts Health NHS Trust, London, UK
| | - R H Ko
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - D Perry
- Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | - G Young
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - R J Luddington
- Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
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Batty P, Hart DP. Computational prediction of phenotype in haemophilia A. Haemophilia 2015; 21:659-61. [PMID: 25952765 DOI: 10.1111/hae.12694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P Batty
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine & Dentistry, QMUL, London, UK
| | - D P Hart
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine & Dentistry, QMUL, London, UK
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9
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Batty P, Honke A, Bowles L, Hart DP, Pasi KJ, Uprichard J, Austin SK. Ongoing risk of thrombosis with factor XI concentrate: 5 years experience in two centres. Haemophilia 2015; 21:490-5. [DOI: 10.1111/hae.12682] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- P. Batty
- St George's University Hospitals NHS Foundation Trust; London UK
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - A. Honke
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - L. Bowles
- The Royal London Hospital; Barts Health NHS Trust; London UK
| | - D. P. Hart
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - K. J. Pasi
- Barts and The London School of Medicine & Dentistry; The Royal London Hospital; QMUL; London UK
| | - J. Uprichard
- St George's University Hospitals NHS Foundation Trust; London UK
| | - S. K. Austin
- St George's University Hospitals NHS Foundation Trust; London UK
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10
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Batty P, Palmer B, Chalmers E, Hay CRM, Liesner R, Rangarajan S, Talks K, Williams M, Collins P, Hart DP. A national survey of immunosuppression strategies for acquired haemophilia A. Haemophilia 2014; 21:e73-6. [PMID: 25422109 DOI: 10.1111/hae.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- P Batty
- The Royal London Hospital Haemophilia Centre, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London, UK
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11
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Hay CRM, Palmer BP, Chalmers EA, Hart DP, Liesner R, Rangarajan S, Talks K, Williams M, Collins PW. The incidence of factorVIIIinhibitors in severe haemophilia A following a major switch from full‐length to B‐domain‐deleted factorVIII: a prospective cohort comparison. Haemophilia 2014; 21:219-226. [DOI: 10.1111/hae.12563] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2014] [Indexed: 12/29/2022]
Affiliation(s)
- C. R. M. Hay
- Manchester University Department of Haematology Manchester Royal Infirmary Manchester UK
| | - B. P. Palmer
- The UK National Haemophilia Database Manchester UK
| | - E. A. Chalmers
- The Department of Haematology Royal Hospital for Sick Children Glasgow UK
| | - D. P. Hart
- The Department of Haematology Barts and The London School of Medicine and Dentistry, QMUL London UK
| | - R. Liesner
- The Haemophilia Centre Great Ormond Street Hospital London UK
| | - S. Rangarajan
- The Haemophilia Centre Guys and St Thomas's Hospital London UK
| | - K. Talks
- The Department of Haematology Newcastle upon Tyne Hospitals NHS Trust Newcastle upon Tyne UK
| | - M. Williams
- The Department of Haematology Birmingham Children's Hospital Birmingham UK
| | - P. W. Collins
- The University Department of Haematology The University Hospital of Wales School of Medicine Cardiff University Cardiff UK
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12
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Batty P, Chen YH, Bowles L, Hart DP, Platton S, Pasi KJ. Safety and efficacy of a von Willebrand factor/factor VIII concentrate (Wilate®): a single centre experience. Haemophilia 2014; 20:846-53. [DOI: 10.1111/hae.12496] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- P. Batty
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
| | - Y. -H. Chen
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
| | - L. Bowles
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
| | - D. P. Hart
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
| | - S. Platton
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
| | - K. J. Pasi
- The Royal London Hospital Haemophilia Centre; Barts and The London School of Medicine and Dentistry; The Royal London Hospital; Whitechapel London E1 1BB UK
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13
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Affiliation(s)
- D. P. Hart
- Barts and The London School of Medicine and Dentistry; Queen Mary University; London UK
- The Royal London Hospital Haemophilia Centre; Barts Health NHS Trust; London UK
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14
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Raza I, Davenport R, Rourke C, Platton S, Manson J, Spoors C, Khan S, De'Ath HD, Allard S, Hart DP, Pasi KJ, Hunt BJ, Stanworth S, MacCallum PK, Brohi K. The incidence and magnitude of fibrinolytic activation in trauma patients. J Thromb Haemost 2013; 11:307-14. [PMID: 23176206 DOI: 10.1111/jth.12078] [Citation(s) in RCA: 340] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Trauma is a global disease, with over 2.5 million deaths annually from hemorrhage and coagulopathy. Overt hyperfibrinolysis is rare in trauma, and is associated with massive fatal injuries. Paradoxically, clinical trials suggest a much broader indication for antifibrinolytics. OBJECTIVE To determine the incidence and magnitude of fibrinolytic activation in trauma patients and its relationship to clot lysis as measured by thromboelastometry. METHODS A prospective cohort study of 303 consecutive trauma patients admitted between January 2007 and June 2009 was performed. Blood was drawn on arrival for thromboelastometry (TEM) and coagulation assays. Follow-up was until hospital discharge or death. TEM hyperfibrinolysis was defined as maximum clot lysis of > 15%. Fibrinolytic activation (FA) was determined according to plasmin-antiplasmin (PAP) complex and D-dimer levels. Data were collected on demographics, mechanism, severity of injury, and baseline vital signs. The primary outcome measure was 28-day mortality. The secondary outcome measures were 28-day ventilator-free days and 24-h transfusion requirement. RESULTS Only 5% of patients had severe fibrinolysis on TEM, but 57% of patients had evidence of 'moderate' fibrinolysis, with PAP complex levels elevated to over twice normal (> 1500 μg L(-1)) without lysis on TEM. TEM detected clot lysis only when PAP complex levels were increased to 30 times normal (P < 0.001) and antiplasmin levels were < 75% of normal. Patients with FA had increased 28-day mortality as compared with those with no FA (12% vs. 1%, P < 0.001), fewer ventilator-free days, and longer hospital stay. CONCLUSIONS FA occurs in the majority of trauma patients, and the magnitude of FA correlates with poor clinical outcome. This was not detected by conventional TEM, which is an insensitive measure of endogenous fibrinolytic activity.
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Affiliation(s)
- I Raza
- Centre for Trauma Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of, London, UK
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16
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Abstract
Patients with inherited bleeding disorders (IBD) can face difficulty in accessing primary dental care either due to disease-specific or patient-related barriers. This can lead to poor oral health and increase the need for more invasive dental treatment. This study aimed to highlight actual and perceived barriers that IBD patients from the East London area were experiencing. It also gives an overview of the experience history of the General Dental Practitioners (GDPs) treating these patients. Information was gathered via pre-designed surveys as part of a service development audit. A total of 105 anonymous patient surveys and 50 GDP surveys were completed between December 2010 and July 2011. The patient survey highlighted more patients to be affected by patient-related than disease-specific barriers to access dental care. The GDP survey identified that just under half of GDPs questioned were not confident in the dental management of patients with bleeding disorders. Identifying misconceptions and barriers to access primary dental care will enable further development of our shared-care approach between General Dental Services, Hospital or Community Dental Services and Haemophilia Centre, optimizing regular preventative advice and follow ups to prevent dental disease and invasive dental treatment requiring haemostatic treatment.
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Affiliation(s)
- H Kalsi
- Royal London Dental Hospital, New Road, London, UK
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17
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Abstract
Bone marrow transplantation has evolved significantly over the past 40 years. The initial rationale of using donor bone marrow to guarantee a supply of hematopoietic stem cells uncontaminated by tumor remains a relevant principle today. However, the donor hematopoietic cells also exert an important immunological, therapeutic effect in the recipient. This synopsis will consider the balance of conditioning therapy intensity and immunological effect of allogeneic stem cell transplantation, informing the positioning of these approaches in current treatment algorithms.
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Affiliation(s)
- D P Hart
- Department of Haematology, University College London Hospital, London, UK
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Thomson KJ, Hart DP, Banerjee L, Ward KN, Peggs KS, Mackinnon S. The effect of low-dose aciclovir on reactivation of varicella zoster virus after allogeneic haemopoietic stem cell transplantation. Bone Marrow Transplant 2005; 35:1065-9. [PMID: 15806119 DOI: 10.1038/sj.bmt.1704959] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients undergoing haemopoietic stem cell transplants (HSCT) are at high risk of varicella zoster virus (VZV) reactivation, with a significant incidence of dissemination. This study reports a retrospective analysis of 247 allogeneic HSCT recipients receiving anti-viral prophylaxis with low-dose oral aciclovir 400 mg/day, administered until immunosuppression was discontinued and the CD4(+) cell count exceeded 200/mm(3). Viral reactivation was successfully suppressed by aciclovir prophylaxis, with only one case of breakthrough infection. The cumulative incidence of zoster infection at 1 year post transplant was 2% and at 5 years 34%. In all, 64 patients discontinued prophylaxis. Zoster developed in 26 of these, giving a cumulative incidence of infection at 1 year after stopping aciclovir of 39% and at 3 years 44%. Infection occurred in a localised dermatomal distribution in 93% of cases. This supports previous findings that aciclovir prophylaxis prevents early VZV reactivation, although the long-term incidence is not affected as infection occurs once prophylaxis is discontinued. Such infection, however, is mild and localised. This study does not support the idea that use of such low-dose aciclovir regimens reduces the zoster incidence by permitting subclinical reactivation during prophylaxis, and therefore the re-establishment of protective anti-viral immunity.
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Affiliation(s)
- K J Thomson
- Department of Haematology, University College London Hospitals, 98 Chenies Mews, London WC1E 6HX, UK.
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Hart DP, Avivi I, Thomson KJ, Peggs KS, Morris EC, Goldstone AH, Linch DC, Ell PJ, Bomanji JB, Mackinnon S. Use of 18F-FDG positron emission tomography following allogeneic transplantation to guide adoptive immunotherapy with donor lymphocyte infusions. Br J Haematol 2005; 128:824-9. [PMID: 15755287 DOI: 10.1111/j.1365-2141.2005.05388.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Fluorine-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) provides valuable prognostic information in the management of lymphoma patients. However, the utility of (18)F-FDG PET following allografting is unclear. We analysed the use of (18)F-FDG PET after allogeneic reduced-intensity transplantation (RIT) performed in our institution. Between June 1998 and January 2002, 55 patients underwent RIT for either Hodgkin or non-Hodgkin lymphoma. At least one (18)F-FDG PET scan was performed during the post-transplant period (median five studies) in 15 (27.2%) of these 55 patients. PET scans were performed after re-staging computed tomography (CT) and were categorised depending on (18)F-FDG uptake. The first PET scan was informative in 11 of 15 patients (73%) and influenced the administration of donor lymphocyte infusions (DLI) in nine: leading to earlier DLI administration in two patients, earlier dose escalation in one, withholding of DLI administration in five and dose reduction in one. In addition, subsequent monitoring with (18)F-FDG PET scans documented a graft-versus-lymphoma effect in five patients (median post-DLI follow-up 33 months, range 13-36 months). These preliminary data suggest that (18)F-FDG PET has a role in guiding DLI administration and monitoring the immunotherapeutic effect in patients after allogeneic transplantation. This retrospective pilot study forms the basis for a prospective study to clarify the utility of (18)F-FDG PET/CT in these patients.
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Affiliation(s)
- D P Hart
- Department of Haematology, University College London Hospital, London, UK
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Morris MJ, Tortelli CF, Hart DP, Delbridge LMD. Vascular and brain neuropeptide Y in banded and spontaneously hypertensive rats. Peptides 2004; 25:1313-9. [PMID: 15350699 DOI: 10.1016/j.peptides.2004.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2004] [Revised: 05/07/2004] [Accepted: 05/07/2004] [Indexed: 10/26/2022]
Abstract
Debate exists regarding the relative importance of neuropeptide Y (NPY) in the pathogenesis of genetic and non-genetic hypertension. NPY concentrations were compared in conduit, mesenteric and renal vasculatures and in hypothalamic and medullary regions of age-matched normotensive control, aortic banded and spontaneously hypertensive rats (SHRs). Lower NPY concentrations were measured in the pre-optic area of banded rats compared to controls and SHR. Renal vein NPY levels were reduced in banded animals, whereas renal artery levels were decreased in SHR. In mesenteric arteries, NPY concentration was selectively increased in SHR. These findings suggest that local hemodynamic alterations influence endogenous levels of this potent vasoconstrictor.
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Affiliation(s)
- M J Morris
- Department of Pharmacology, The University of Melbourne, Parkville, Vic. 3010, Australia.
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Wyslouzil BE, Whipple M, Chatterjee C, Walcerz DB, Weathers PJ, Hart DP. Mist deposition onto hairy root cultures: aerosol modeling and experiments. Biotechnol Prog 1997; 13:185-94. [PMID: 9104040 DOI: 10.1021/bp960093h] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We analyzed the applicability of the standard models for aerosol deposition in randomly packed fibrous filter beds to mist deposition across a bed of hairy roots in the nutrient mist bioreactor. Although the assumptions inherent in the models are met on a local level, the overall structure of the root bed introduces some uncertainty into the correct choice of root packing fraction and gas velocity required by the model. For reasonable parameter values, the minimum in the deposition efficiency curves is close to the peak in the mist number and mass distributions, and good penetration of the root bed is possible. We then measured the deposition of mist across a packed bed of Artemisia annua transformed roots as a function of droplet size, bed length, and gas flow rate at a root packing fraction alpha = 0.5. We compared the experimental measurements with the predictions of the aerosol deposition model and found good agreement between the measured and predicted values for the diameter where the deposition efficiency across the bed is 50%, D0.5. Agreement between the model and the experiments broke down when the flow rate was increased to the point where the creeping flow assumptions were no longer valid.
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Affiliation(s)
- B E Wyslouzil
- Department of Chemical Engineering, Worcester Polytechnic Institute, Massachusetts 01609-2280, USA
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Hart DP, Vanderwall CF. The role of a community psychiatric nurse in prison healthcare. J Clin Forensic Med 1995; 2:81-3. [PMID: 15335653 DOI: 10.1016/1353-1131(95)90069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
It is now 2 years since a trained and experienced psychiatric nurse became attached to our Health Care Centre to assist in counselling and treating mentally disordered offenders. The attachment represents innovation within the Prison Service and the nurse has developed into a most valuable asset within the health care team. We report on the attachment, the workload and the role of the nurse.
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Affiliation(s)
- D P Hart
- Her Majesty's Prison Bedford, UK
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Hart DP, Dahners LE. Healing of the medial collateral ligament in rats. The effects of repair, motion, and secondary stabilizing ligaments. J Bone Joint Surg Am 1987; 69:1194-9. [PMID: 3667648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The effects of repair, motion, and the integrity of the secondary ligamentous restraints on healing of the medial collateral ligament were studied in a rat model. Healing was assessed by measuring ligamentous laxity and tensile strength. All healing ligaments were weaker and more lax than their controls. Repair did not have a statistically significant effect on the laxity or the strength of the medial collateral ligament. Allowing active motion had a statistically significant beneficial effect on the strength of the medial collateral ligament. Stability was adversely affected by active motion if the secondary restraints had been transected; however, when the secondary ligamentous restraints were intact, active motion was beneficial and immobilization was harmful.
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Affiliation(s)
- D P Hart
- Department of Surgery, University of North Carolina at Chapel Hill
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Hart DP, Blair WF. Acute dorsal fracture-dislocation of the proximal interphalangeal joint. J Iowa Med Soc 1983; 73:359-63. [PMID: 6631083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
Serum uric acid (SUA) was measured in 512 men and 254 women from two English regions and in 337 men from one Scottish region. Mean SUA levels were the same in the men (5-5 mg/100 ml) and similar in the women (3-9 and 4-1 mg/100 ml). The apparent rarity of gout in Scotsmen cannot be explained by regional differences in SUA levels or in the prevalence of hyperuricaemia (defined as SUA of 7-0 mg/100 ml or over) which was present in 6-6% of the English men and 8% of the Scots. SUA was positively correlated with weight and serum urea, and with age in women, but no variation was found with social class. Body weight was the most important predictor of SUA in both men and women and superior to measurements involving correction for height, such as ponderal index and calculated lean body mass.
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Abstract
A survey of serum uric acid levels in 766 subjects in England and 337 in Glasgow was carried out. There was no difference in the frequency distribution of uric acid or the mean levels in the two countries. A serum uric acid of 7 mg/100 ml or over was found in 7.2% of the men and 0.4% of the women. The previously described sex difference and association of serum uric acid with weight were confirmed. No association was found with social class. The suggestion of an increase in uric acid levels in the United Kingdom over the past 14 years is discussed.
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